How do you manage patients with suspected cholangiocarcinoma that presents with biliary obstruction but has repeated negative brushings/biopsies?   

This is often encountered in patients with PSC. Patients present with jaundice and biliary stricture, rising CA 19-9, and repeat ERCP with brushing/biopsies have shown no evidence of malignancy (often showed abnormal cells). Brushings have high specificity if positive (99%) but very poor sensitivity...

Agree with Dr. @Tran's answer. This specific scenario here likely describes non metastatic perihilar or distal cholangiocarcinoma. The first thing is to ensure advanced endoscopic attempts have been exhausted including spyglass-directed biopsy, etc.  As Dr. Tran indicated, frequently occurs in...